Frequently Asked Questions

We are currently offering two doses of Fluenz to all children aged between 2 and 9 - these are given four weeks apart. If you have been offered only a single dose for your child, under the NHS, we would be happy to provide a further dose, if you would like us to.

We would always advise you to seek appropriate religious advice, but the following facts may help inform this for you.

Standard injected vaccines

Standard vaccines are made from viruses that are grown in culture (in order to yield sufficient quantity to turn into vaccines). All flu viruses need mammalian cells in which to grow. The standard flu vaccine production method is to inoculate "seed" virus into embryonated (i.e. fertilised) hens' eggs. Hens are kosher animals, and hens' eggs are kosher. The situation regarding embryonated hens' eggs might be a little more complicated, but these should be kosher also - Jewish law permits eating eggs found inside a chicken, and these may well be fertilised or embryonated.

We do vaccinate a great many observant Jewish and Muslim patients, who have never found themselves in difficulty about this aspect of the vaccine.

Other points to consider:

1. Having grown in culture, the virus particles are extracted, killed and purified, so it is very doubtful how much actual egg material remains in the vaccine - only a trace at most.

2. Jewish law specifically permits anything to be done in the cause of saving life, and flu vaccine is certainly in this category.Fluenz

Fluenz - the live vaccine currently offered to children - contains traces of modified pork gelatin, and therefore raises concerns about acceptability to observant Muslims and Jews, especially given that alternatives are available.

There are now also vaccines available that are "egg-free" - made in cell culture, partly to avoid the issue of egg allergy. These vaccines are made in cell culture lines grown originally from canine kidney cells. However, the considerations discussed above also apply here, especially most people opting for the egg-free vaccine would be doing so in order to reduce the possibility of an allergic reaction.

We shall stock more than one dozen different flu vaccine brands this season. In just one of them, thiomersal is used as a preservative during part of the manufacturing process; it is later removed, but there is a thoretical possibility that a trace may remain. We always bring a choice of vaccines to our workplace sessions, so do tell usif you would prefer to receive a different vaccine.

In the UK as well as most other countries, flu vaccines are only licensed for use in babies aged over 6 months. However, a recent study in the United States of 1375 infants aged just 6-12 weeks confirmed that flu vaccine was safe and effective in this age group also, and therefore might be considered under special circumstance. Vaccinating mothers in pregnancy also passes immunity to the newborn baby.

There's no problem being vaccinated when you or your child have a cold or a minor illness. However, we prefer not to vaccinate people who have a fever, since the immune response to the vaccine may not be as good.

Yes. The H1N1 pandemic vaccine only protected against H1N1 flu, and it is uncertain how long protection lasts. This year's seasonal flu vaccine protects aganst three strains including H1N1, and therefore gives worthwhile additional protection.

No, sorry. In special cases, we sometimes do allow individual patients who attend the practice in person, to take away vaccine doses for family members. If you would like this to be considered, you would need approval from your local GP practice, and you would have to put us in direct touch with them so that we can confirm that they are happy to administer vaccine for you.

Timing issues mainly apply to live vaccines like MMR, chickenpox (varicella) and BCG, which should generally either be given on the same day as each other, or with at least a 4-week gap. These issues don't apply to injected flu vaccines, which are "killed" vaccines. However, they may theoretically apply to the use of FLUENZ, the nasally administered vaccine which is currently being offered to children. Do tell the doctor or nurse about any vaccines that are likely to be due, or have recently been given, so that we can give you the best advice.

Don't be worried. At the start of the H1N1 swine flu pandemic, the first vaccines had to be manufactured very quickly, and contained additives (called adjuvants) to enhance the immune response. Many people who received those vaccines did experience a high rate of minor side effects - but these were caused by the adjuvants, and had nothing to do with the H1N1 component. Seasonal flu vaccines DO NOT contain these adjuvants. Seasonal flu vaccines protecting against H1N1 have not been linked to any increase in the rate of side effects.

From birth, baby's immune systems protect them from the germs that surround them. Without this protection, babies would not be able to cope with the tens of thousands of bacteria and viruses that cover their skin, nose, throat and intestines. Vaccines are designed to strengthen a baby's immune system and protect them from very serious diseases. There is no evidence that any vaccine programme overloads a child's immune system. In the US, where more vaccines are given in a single GP visit than in the UK, a study (Offit et al, 2002) found no difference in hospital admission in children who had had multiple immunisations compared with children who had had only polio vaccine. In theory, a baby could response safely and effectively to around 10,000 vaccines at any one time (Offit et al, 2002) . So a baby's immune system can and does easily cope with the addition of additional doses of vaccine to the immunisation programme.

Flu vaccines are "killed" vaccines. The National Blood Service does not require any delay between vaccination and blood donation, for this category of vaccine, so there's no problem. The National Blood Service Helpline is 084577 11 711

The vaccine production process includes culture in embryonated hens' eggs. Only a trace of egg protein remains in the vaccine, but some strict vegetarians may object to this. If you have religious reasons for avoiding eggs, you should take appropriate religious advice. There is also a cell-culture vaccine, which is free of egg proteins, and which could be used if you prefer.

Yes, protection against seasonal flu and H1N1 flu is a sensible precaution, and swine flu protection is currently advised for UK travellers to the southern hemisphere. Additional risks for travellers include a higher risk of transmission of airborne respiratory infection during flights, and well-documented outbreaks of flu on cruise ships, so flu vaccination is a precaution that is well worth taking.

Yes. There's no reason not to vaccinate children, and plenty of benefit. If they've not been vaccinated before they generally need a second dose 4 weeks after the first, for full effect. Children can be vaccinated from the age of six months.

Most flu vaccines are administered by injection into the deltoid muscle, so it is generally considered sensible to avoid strenuous exercise for several hours after vaccination, though this is not an absolute rule: if you do go, take it easy. You could also consider asking to receive an intradermal flu vaccine: this type of vaccine is given into the top skin layer, so there should be no problem if you need to exercise.

Please tell the doctor or nurse giving the vaccine about any important aspects of your medical history, and about any medication you are taking. Flu vaccine does not interact with any other vaccine or medication. However, any treatment that might reduce your immunity can reduce the effectiveness of the immune response. Vaccination can briefly affect the results of certain types of blood tests (serology tests), so if you have a blood test within a few days of being vaccinated, please ask the person taking the blood sample to mention your flu jab on the laboratory form.

Yes. There is now wide experience of using flu vaccines during pregnancy, and pregnant women are known to be at significantly increased risk from complications of H1N1 and perhaps seasonal flu as well, so vaccination is strongly advised.

Vaccinating mothers against flu before or during pregnancy can provide the newborn baby with significant "passive" protection lasting several weeks - this is important because babies cannot be vaccinated themselves until they are 6 months old.

If you are considering pregnancy in the coming months, it would be sensible to consider vaccination before you become pregnant.

Well-documented, severe allergy means that you should not be vaccinated using vaccine produced in eggs. True egg allergy is very rare: we will usually vaccinate people who report no problem eating egg products such as cakes or egg pasta. If you are uncertain, talk things over with your doctor, or with the doctor or nurse giving the vaccine. Alternatively, a vaccine called Optaflu may be available during 2013/14 - this vaccine is produced in cell culture and is free of egg proteins, so is ideal for people concerned about egg allergy.

Flu vaccines are very safe. The commonest problem after vaccination is slight soreness of the arm at the point where the injection was given; and less often, slight temperature and aching muscles can occur for a couple of days, but this responds easily to remedies like paracetamol; or redness and irritation at the injection site, sometimes lasting 2 or 3 days - it responds to taking ibuprofen and applying a cold flannel. The risk of more serious reactions is extremely small - of the order of one in a million, or less; and considerably smaller than the risk of serious complications from the illness itself.

About 6-12 months. The vaccine protects against different strains, and the protection against some of the strains may last longer than others. Longer lasting flu vaccines are currently at a research stage.

The best time to be vaccinated is between late September and December, ready for the winter. If you wait until there is a flu epidemic in progress, it may not otherwise be possible for you to get good protection quickly enough.

Flu vaccinations are 70-80% effective, provided that there is a good match between the strains used to make the vaccine, and the strains of flu that are going around. There are very sophisticated systems in place for monitoring strains of flu around the world, so it is increasingly possible to predict which strains are most likely to cause trouble. Protection is excellent against the strains from which the vaccine is made, and even if you catch the flu, the illness will almost certainly be milder than if you had not been vaccinated.

The benefits of vaccination to healthy, working adults and their employers are well-established: vaccination cuts the risk of 'flu by approximately 70-80%, and reduces time off work from colds and flu by forty three per cent. Each winter, up to one third of British adults may suffer from flu, and one third of sufferers become ill enough to visit their doctor. For companies and organizations, the potential benefits are even greater than the benefits to the individual: respiratory viruses can spread easily within any large group of people, working together and sharing facilities on the same site. It is to everyone's advantage that as many people as possible within the same organization should be protected.

Only to the particular strain of flu that caused the infection. The virus changes over time, and new strains appear. Protection from past infection or previous vaccination is unreliable - the most effective way of increasing your protection is to be vaccinated every year.

The commonest symptoms are: rapid onset of fever, shivering, headache, muscle aches, and a cough. Flu causes a much more severe illness than the common cold: a cold doesn't cause fever or muscle aches. People with flu can feel very ill indeed, often resulting in several days of being confined to bed. Most people recover easily, but would have much preferred to avoid the experience altogether, which is where flu vaccine comes in. For some victims, flu can cause more serious complications, like bronchitis and pneumonia - potentially life-threatening in the elderly, asthmatics and those with pre-existing medical conditions.

Flu vaccination does reduce illness during the winter, and the illness can sometimes be very serious. In the UK, attitudes to flu are muddled by the fact that the vaccine is usually only offered free to people in designated categories - usually people at special risk from complications (check with your GP to see if you are entitled to free vaccination). In other countries, the situation is different. In the USA, for example, annual vaccination for healthy working adults is very much a routine, and is widely regarded as an important health benefit. Key workers, highly paid staff, those working in direct contact with the general public or in public places, staff in large open plan offices (i.e. sharing the same air) and staff who simply have caring employers, are among those generally offered free vaccination in the workplace. While there is certainly a benefit to employers in helping staff stay healthy, flu vaccination protects your leisure time and your family as well, and not just your ability to work. Don?t forget, the flu season begins at Christmas, and ends around the Easter break.

Each flu season, all vaccines are prepared to the latest WHO specifications; WHO recommends that trivalent vaccines for use in the 2014-2015 influenza season (northern hemisphere winter) contain the following:

• an A/California/7/2009 (H1N1)pdm09-like virus;

• an A/Texas/50/2012 (H3N2)-like virus;

• a B/Massachusetts/2/2012-like virus.

Where a fourth strain is included in the vaccine, the WHO recommends that this should be a B/Brisbane/60/2008-like virus.